Carpal Tunnel Syndrome (CTS) is a common condition that involves the compression of a nerve in the wrist. It can cause pain, tingling, and numbness in your hand and fingers as well as weakness in your grip. If left untreated, carpal tunnel syndrome can significantly affect daily activities.
If you are experiencing discomfort or pain in your wrists or hands, read on to learn about the causes, symptoms, diagnosis and treatment options for CTS so you can make an informed decision about your care.
History and Definition
Carpal tunnel syndrome is a condition that affects the hand and wrist, causing pain, numbness, and tingling in the fingers. It occurs when the median nerve, which runs from the forearm to the hand, becomes compressed or squeezed as it passes through a small opening in the wrist called the carpal tunnel. This can happen due to several factors such as repetitive motions, arthritis, pregnancy, and obesity.
In 1854, the first accounts of median nerve compression in the carpal tunnel were recorded. However, it wasn’t until a full century later that individuals began referring to this condition as “carpal tunnel syndrome” (CTS). Before CTS was officially recognized, patients whose symptoms were now known to be caused by this disorder were sometimes misdiagnosed with acroparaesthesia or compression of the motor branch of the median nerve or brachial plexus.
The surgical technique for treating this affliction through opening up the carpal tunnel was introduced in 1933 and then further defined by Brain and Phalen as idiopathic CTS from both clinical and anatomical perspectives.
Symptoms
Carpal tunnel syndrome (CTS) is a condition that affects the hand and wrist, causing a variety of symptoms that can range from mild to severe. Some of the most common symptoms of CTS include:
- Weakness when gripping objects with one or both hands
- Pain or numbness in one or both hands
- “Pins and needles” feeling in the fingers
- Swollen feeling in the fingers
- Burning or tingling in the fingers, especially the thumb and index and middle fingers
- Pain or numbness that is worse at night, interrupting sleep
It’s important to note that these symptoms of CTS may be similar to other medical conditions or problems, therefore it’s always best to see a healthcare provider for a proper diagnosis.
Causes
Carpal Tunnel Syndrome (CTS) is a condition caused by pressure on the median nerve. The median nerve is responsible for providing sensation to the palm side of the thumb and fingers, except for the little finger, and also for providing nerve signals to move the muscles around the base of the thumb.
The median nerve runs from the forearm through a passageway in the wrist, called the carpal tunnel, to the hand. Anything that squeezes or irritates the median nerve in the carpal tunnel space can lead to CTS. Some examples of conditions that can cause CTS are:
Wrist fractures
A wrist fracture can narrow the carpal tunnel, which may irritate the nerve.
Rheumatoid arthritis
The swelling and inflammation caused by rheumatoid arthritis can also cause CTS.
In many cases, there is no single cause of CTS, it may be that a combination of risk factors contributes to the development of the condition.
Diagnosis
Carpal tunnel syndrome (CTS) can be diagnosed through a combination of medical history, physical examination, and diagnostic tests.
- Medical history: Your healthcare provider will ask about your symptoms, including the pattern of your symptoms, such as numbness, pain, or tingling in the fingers and wrists, and when they occur. They will also ask about any related medical conditions or risk factors that may contribute to CTS.
- Physical examination: Your provider will conduct a physical examination, testing your feeling in the fingers and the strength of the muscles in the hand. They will also perform specific tests to check for signs of CTS, such as tapping on the median nerve or bending the wrist.
- Diagnostic tests: Your provider may recommend one or more of the following tests to confirm the diagnosis of CTS:
- X-ray: This test can help rule out other causes of wrist pain such as arthritis or a fracture.
- Ultrasound: this test can provide a clear picture of the bones and nerves in the wrist, helping to determine if the median nerve is being compressed.
- Electromyography (EMG): This test records the electrical activity of muscles to determine if the median nerve is damaged or if other conditions may be causing the symptoms.
- Nerve conduction study (NCS): This test involves passing a small electrical shock through the median nerve to measure the speed of electrical impulses. This test can confirm the diagnosis of CTS and rule out other conditions.
It is important to consult with a healthcare provider for a proper diagnosis and treatment plan for carpal tunnel syndrome.
Treatment
Treatment for carpal tunnel syndrome (CTS) can be divided into two main categories: non-surgical and surgical. The appropriate treatment will depend on the severity of the condition and the individual’s preferences.
Non-Surgical
- Wearing a wrist splint at night to immobilize the hand and wrist, can reduce pressure on the median nerve.
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
- Cortisone injections reduce inflammation and provide temporary relief.
- Occupational therapy or ergonomic adjustments to the work environment to reduce repetitive movements and improve posture.
Surgical
- Carpal Tunnel Release (CTR) surgery is the most common surgical treatment for CTS. The goal of surgery is to increase the size of the carpal tunnel by cutting the transverse carpal ligament to relieve pressure on the median nerve.
- The procedure is typically done as an outpatient and may be performed under local or IV anesthesia.
- Recovery time varies from person to person, but most people experience complete symptom relief quickly and can resume normal activities within a few weeks of surgery.
- Surgery is usually recommended for cases that do not respond to non-surgical treatments or for severe cases of CTS.
It is important to consult with a healthcare provider to determine the best treatment plan for carpal tunnel syndrome.
Risk Factors
Carpal tunnel syndrome is a common condition that affects millions of people each year. Several factors can contribute to its development such as:
- Age: One’s age can be a contributing factor to CTS. As we get older, the tendons in our wrists become thicker and more rigid, putting increasing pressure on the median nerve.
- Gender: Women are three times more likely than men to experience CTS due to anatomical differences, such as narrower carpal tunnels and smaller wrists.
- Repetitive Use: Engaging in activities that involve repetitive hand motions or using vibrating tools can cause inflammation of the tendons and ligaments around the wrist, leading to increased pressure on the median nerve.
- Obesity: Being overweight increases a person’s risk of developing this condition because it adds strain to the wrist joints.
- Smoking: Evidence suggests that smoking can also increase one’s risk of CTS due to it having a negative effect on the vascular system.
- Diabetes: Individuals with diabetes may have more difficulty controlling their blood sugar levels, which in turn can lead to nerve damage, increasing the chances of developing carpal tunnel syndrome.
- Injury or Fracture: Any kind of wrist injury or fracture can put pressure on the median nerve, leading to symptoms of CTS.
- Heredity: Some people are born with smaller than average carpal tunnels and this can cause increased pressure on the median nerve, making them more prone to CTS.
- Pregnancy: Many pregnant women experience fluid retention in their wrists, which can put pressure on the median nerve, leading to CTS.
- Thyroid Conditions: Abnormal levels of thyroid hormones can cause swelling in the wrists, increasing pressure on the median nerve and resulting in CTS.
- Rheumatoid Arthritis: This autoimmune disorder causes inflammation of small joints such as those found in the wrist, leading to increased pressure on the median nerve and symptoms of CTS.
- Work Environment: Working with vibrating tools or performing repetitive motions with your hands can increase strain on your wrists, making you more prone to developing carpal tunnel syndrome.
It’s important to note that some of these risk factors, such as workplace factors and computer use, have conflicting evidence and have not been established as direct causes of CTS.
Complications
Carpal tunnel syndrome (CTS) is a condition caused by the compression of the median nerve in the wrist. This can lead to a variety of symptoms including numbness, tingling, and weakness in the hand and fingers. Over time, if left untreated, CTS can lead to several complications.
- Muscle weakness and atrophy: The median nerve controls the muscles in the thumb, so if the nerve is compressed, the muscles may weaken and shrink. This can make it difficult to grasp and hold objects.
- Difficulty with fine motor tasks: As the condition progresses, it can become increasingly difficult to perform tasks that require precise hand movements, such as buttoning a shirt or tying shoelaces.
- Chronic pain: The pain may radiate from the wrist up the arm, and can be severe enough to disrupt sleep.
- In severe cases of CTS, the median nerve may become permanently damaged leading to a loss of sensation and muscle function in the hand. This can result in permanent disability.
Surgery is considered when the symptoms are severe and persistent, and not responding to conservative treatment. It is important to seek early treatment for CTS to prevent complications from developing.
When to See a Doctor
It is recommended to see a doctor if you experience any of the following symptoms associated with carpal tunnel syndrome:
- Numbness, tingling, or a burning sensation in the hand and fingers, especially the thumb, index, and middle fingers
- Weakness in the hand and fingers
- Difficulty grasping or holding objects
- Pain or discomfort in the wrist, hand, or arm
- A feeling of swelling in the hand, even though there may be no visible swelling
These symptoms may be worse at night and may wake you up. If you have any of these symptoms, it is important to see a doctor as soon as possible. The earlier CTS is diagnosed and treated, the better the outcome is likely to be.
Step-by-Step Guide to Carpal Tunnel Syndrome Treatment
Treatment for carpal tunnel syndrome (CTS) typically begins with conservative measures and progresses to more invasive options as needed. Here is a step-by-step guide to CTS treatment:
Consultation
During the initial consultation, your doctor will ask about your symptoms and medical history and perform a physical examination of your hand, wrist, and arm. They may also ask about your job and any activities that may be contributing to your symptoms.
Diagnostic Tests
Your doctor may order certain tests to confirm the diagnosis of CTS. These may include a nerve conduction study (NCS) and electromyography (EMG) to measure the electrical activity of the median nerve, and imaging tests such as X-ray or MRI to rule out other conditions.
Treatment Plan
Based on the results of the examination and diagnostic tests, your doctor will develop a treatment plan tailored to your specific needs.
- Conservative Treatment: Your doctor will likely recommend starting with conservative treatment options, such as rest, immobilization, and physical therapy. They may also recommend over-the-counter pain medication to reduce inflammation and pain.
- Further Treatment: If conservative treatment options are not effective, your doctor may recommend other treatment options such as corticosteroid injections or surgery.
Follow-Up
Your doctor will schedule follow-up appointments to monitor your progress and adjust your treatment plan as needed.
It is important to discuss any concerns or questions you have with your doctor and to follow their recommendations for treatment and follow-up care. In the case of surgery, the recovery and rehabilitation process will be discussed and explained in detail.
Conclusion
Carpal tunnel syndrome is a common nerve disorder caused by compression of the median nerve as it passes through the wrist. This can cause pain, tingling, and numbness in your hand and fingers. The good news is that there are effective treatment options available for those suffering from carpal tunnel syndrome.
No matter what treatment option you choose, it is important to recognize carpal tunnel syndrome early on and take the necessary steps to seek help and find relief. With proper management, you can reduce your discomfort and prevent further damage.
The earlier carpal tunnel syndrome is addressed, the more likely it is that you will find relief and continue to enjoy life with minimal disruption. Don’t wait for the symptoms of carpal tunnel syndrome to worsen before seeking help; take control of your health today. With the right combination of treatments, you can reduce your discomfort and get back to living life to its fullest.
BOOK AN APPOINTMENT TODAY
Are you suffering from carpal tunnel syndrome? Dr. Colin Hong is a highly experienced Plastic Surgeon in Toronto, with over 35 years of practice in Cosmetic, Plastic, and Reconstructive Surgery. He offers some of the most affordable costs in North York and Markham.
If you are interested in learning more about treatment options for this condition, contact his office today to schedule an appointment. Please dial (416) 222-6986 or email info@drcolinhong.com with your name, email address, and telephone number so we can contact you as soon as possible. Please also obtain a referral from your family doctor to set up an appointment with Dr. Colin Hong.
Frequently Asked Questions
Related Services:
Cubital Tunnel Syndrome
Nerve Lacerations
Extensor Tendon Lacerations
Amazing experience, Doctor Hong is very confident and good at what he does. Every time I go to him I always get good results that I love and feel safe. Very friendly and helpful staff!